NPIMap

Organization Active NPI

St. Edward Mercy Clinic, Inc.

  • Physical Therapist
  • Fort Smith, AR
National Provider Identifier
1730486556
Registry record updated Dec 2, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
ST. EDWARD MERCY CLINIC, INC.
Practice address
3501 We Knight Drive
Fort Smith, AR 72903-6248
Phone
(479) 709-6700
Fax
(479) 709-6709
NPI assigned
Feb 14, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 2, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Raymond Cole Goodman Jr., M.D.
Title
President
Phone
(479) 314-6100

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X Primary
Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225X00000X

Addresses

Primary practice location

3501 We Knight Drive
Fort Smith, AR 72903-6248

Mailing address

PO Box 11230
Fort Smith, AR 72917-1230
Phone (479) 709-6767

Other identifiers 3

IdentifierTypeStateIssuer
5G410OtherARBLUE CROSS BLUE SHIELD
200199350JMedicaidOK
DR1533OtherARRAILROAD MEDICARE

Other names 1

  • Mercy Clinic River Valley Therapy Services Doing business as

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1297641600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1322784000000",
    "number": "1730486556",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 11230",
            "city": "FORT SMITH",
            "state": "AR",
            "postal_code": "729171230",
            "telephone_number": "479-709-6767",
            "fax_number": "479-709-6768"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3501 WE KNIGHT DRIVE",
            "city": "FORT SMITH",
            "state": "AR",
            "postal_code": "729036248",
            "telephone_number": "479-709-6700",
            "fax_number": "479-709-6709"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. EDWARD MERCY CLINIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-02-14",
        "last_updated": "2011-12-02",
        "status": "A",
        "authorized_official_last_name": "GOODMAN",
        "authorized_official_first_name": "RAYMOND",
        "authorized_official_middle_name": "COLE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "479-314-6100",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "5G410",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200199350J",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DR1533",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mercy Clinic River Valley Therapy Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fort Smith, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.